TY - JOUR
T1 - Heart Rate Variability - a Therapeutic Target?
AU - Routledge, Helen
AU - Chowdhary, Saqib
AU - Townend, Jonathan
PY - 2002/4/1
Y1 - 2002/4/1
N2 - Reduced heart rate variability (HRV) is a powerful and independent predictor of an adverse prognosis in patients with heart disease and in the general population. The HRV is largely determined by vagally mediated beat to beat variability, conventionally known as respiratory sinus arrhythmia. Thus, HRV is primarily an indicator of cardiac vagal control. It is still unclear whether the relationship between measures of cardiac vagal control and mortality is causative or mere association. Possible mechanisms by which cardiac vagal activity might beneficially influence prognosis include a decrease in myocardial oxygen demand, a reduction in sympathetic activity and a decreased susceptibility of the ventricular myocardium to lethal arrhythmia. In animals, augmentation of cardiac vagal control by nerve stimulation or by drugs is associated with a reduction in sudden death in susceptible models. In humans a number of drugs which have been shown to reduce mortality and sudden death in large randomised trials can also be demonstrated to increase HRV. As a result of this evidence, it has been suggested that the effect of drugs or other therapeutic manoeuvres on HRV might be used to predict clinical efficacy. The use of HRV as a therapeutic target is discussed in this review.
AB - Reduced heart rate variability (HRV) is a powerful and independent predictor of an adverse prognosis in patients with heart disease and in the general population. The HRV is largely determined by vagally mediated beat to beat variability, conventionally known as respiratory sinus arrhythmia. Thus, HRV is primarily an indicator of cardiac vagal control. It is still unclear whether the relationship between measures of cardiac vagal control and mortality is causative or mere association. Possible mechanisms by which cardiac vagal activity might beneficially influence prognosis include a decrease in myocardial oxygen demand, a reduction in sympathetic activity and a decreased susceptibility of the ventricular myocardium to lethal arrhythmia. In animals, augmentation of cardiac vagal control by nerve stimulation or by drugs is associated with a reduction in sudden death in susceptible models. In humans a number of drugs which have been shown to reduce mortality and sudden death in large randomised trials can also be demonstrated to increase HRV. As a result of this evidence, it has been suggested that the effect of drugs or other therapeutic manoeuvres on HRV might be used to predict clinical efficacy. The use of HRV as a therapeutic target is discussed in this review.
UR - http://www.scopus.com/inward/record.url?scp=0036252412&partnerID=8YFLogxK
U2 - 10.1046/j.1365-2710.2002.00404.x
DO - 10.1046/j.1365-2710.2002.00404.x
M3 - Article
C2 - 11975691
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
SN - 1365-2710
VL - 27
SP - 85
EP - 92
JO - Journal of Clinical Pharmacy and Therapeutics
JF - Journal of Clinical Pharmacy and Therapeutics
IS - 2
ER -